Provider Demographics
NPI:1386833713
Name:LANTZMAN, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:LANTZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 N LAUGHLIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-9067
Mailing Address - Country:US
Mailing Address - Phone:707-528-7999
Mailing Address - Fax:
Practice Address - Street 1:3663 N LAUGHLIN RD STE 103
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-9067
Practice Address - Country:US
Practice Address - Phone:707-528-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter